80 Days Later…

80 days.

That’s how long it took for me to receive the letter from my health insurance company notifying me (at long last) that the pre-authorization for my Dexcom supplies came through – and more importantly, was approved.

Those 80 days were fraught with anxious thoughts. On a daily basis, I wondered…

When would I get my next Dexcom order? Answer: Almost three full months after I started my new job and switched health insurance.

Would I even still be able to use Dexcom under my new health plan? Answer: Yes, although I wasn’t sure for a long time seeing as I didn’t find out until recently that I needed a prior authorization in order to get Dexcom coverage.

Why was it taking so long? Answer: It took so long partly because this stuff can be time-consuming. I work full-time, maintain a home, care for my dog, and juggle a jam-packed social calendar…and don’t often have the bandwidth to be waiting on hold with my doctor’s office, my health insurance provider, and my Dexcom supplier. I was counting on all three of the aforementioned parties to do a little more of the heavy lifting for me when I should’ve depended on myself alone to make sure I got my supplies as quickly as possible.

What was I doing wrong? Answer: Honestly, even though I sound like I’m shouldering most of the responsibility in the latter paragraph, I don’t think it’s fair to pin this all on me. Sure, I could’ve and should’ve hustled harder to get my Dexcom supplies, but I put trust in a system that I already knew is fundamentally broken. Health insurance can be ridiculous complicated to understand and contend with. I’d never needed a prior authorization for anything before, so that concept was new to me. Throw a new health plan that I had zero familiarity with into the mix and I was bound to encounter some bumps in the road to get my supplies.

I was so excited to get this letter in the mail that I took a damn picture with it.

That’s why I almost cried tears of relief and joy when I finally got the letter from my insurance company that informed me my Dexcom supplies were approved. The waiting period was over. 80 days of fretting over whether or not I’d have access to a tool that has revolutionized my diabetes care and management was absolute agony. That period of time also represented the first time I was truly worried over whether or not I could continue with the diabetes regimen that works for me. I was trying to remember the days before my Dexcom, the days that I had finger pricks and finger pricks alone to base my diabetes decisions on.

I could scarcely remember those days. And the fact that they could’ve become my new reality if I didn’t figure out the Dexcom situation frightened me.

I feel very fortunate that I was eventually able to successfully place an order for my Dexcom supplies under my new health plan, but I also feel rage that the system made it so difficult, as well as utter heartbreak for those who don’t have choice when it comes to diabetes supplies or even access to life-altering (and life-saving) medications.

I’ve said it before and I’ll say it again…our healthcare system is broken. Choice and access matter.

They matter most of all when lives depend on it.

Switching Jobs Means Switching Health Insurance: My 4 Tips on How to Make the Transition Easier

Hi, my name is Molly and I have type 1 diabetes, and although I am extremely grateful for health insurance, I also hate every aspect of it.

When I aged out of my parents’ health insurance plan two years ago, I was completely lost and overwhelmed by choosing my new plan. How much would I have to pay for my supplies? Would everything be covered? Could I keep my doctors? How much money should I put into my FSA? The answers to these questions took me a good chunk of time to figure out, and I only started feeling good about my knowledge of my old job’s health insurance plan in the last year or so.

As a result, the only thing that made me less excited to start my new job was the burden of having to figure out a new health insurance plan. And for good reason, it turns out, because it has been a challenge to say the least. But there are a handful of things I’ve learned along the way that I don’t think I’ll ever forget so that I can have an better experience the next time I need to change health plans. Here are my tips for making the transition from one health insurance plan to another as easy as possible:

1. Take stock of ALL my supplies before starting the new job (and before losing my old job’s health coverage). This was, without a doubt, the best thing I could’ve done for myself before I started my new job. In my last few weeks with my former company, I looked through all of my diabetes supplies and inventoried them. I kept a running list of the most important items (things like insulin, Dexcom sensors/transmitters, and pods) and decided that even if I had plenty of those things, I would still place an order for them before losing my health insurance. This ended up being a fantastic idea because it took me a solid couple of weeks at my new job to figure out which health plan would work best for me, and in that span of time, my supply stash was dwindling. On top of that, it took several more weeks for me to get all my prescriptions straightened away (more on that in tip 3), so I was especially grateful that I had seriously stocked up before leaving my old job.

2. Compare plans extensively. Like I mentioned above, I spent a couple weeks reading through my plan options before I finally settled on one. It took me so long because I wanted to feel 100% comfortable with my new plan, and I knew that I had a 4-week period to complete my research before committing to a new plan. Plus, my new job uses a website that offers a health insurance plan comparison tool (a super cute one, to boot, that explains all things insurance in layman’s terms) that I was happy to take advantage of during the decision-making process.

What tips would you have for someone who is switching health insurance plans?

3. Send as many messages and make as many phone calls as it takes until everything about the new plan is crystal clear. For me, this including calling my local pharmacy and sending toooons of online messages to my doctor’s office, as well as my new health insurance provider. I honestly felt like I was playing a game of telephone – you know, that game that kids play where they have to whisper a message into each other’s ears as a test of listening and communicating effectively – because it seemed that nobody would take accountability for sending my prescriptions to the right place or understanding exactly how I needed help. So in the last few weeks of July (leading into the first few weeks of August, really, ‘cuz I’m still working on this), I made a vow to myself that I’d get to the bottom of everything and get my prescriptions fully straightened away. I’m happy to report I’ve made substantial progress, but I’d be lying if I said it didn’t require a lot of my spare time and energy.

4. Talk to coworkers and ask for their feedback on plans. This might be unique to me because I work for a diabetes organization and my colleagues have an intimate knowledge of health insurance hurdles combined with a chronic illness, but even so, I remember asking coworkers at my previous job about their thoughts on the health insurance offerings and I got some solid feedback from that. So that’s why I decided to ask around at the new job, and of course I was met with helpful replies that made my transition a little smoother.

The biggest lesson I learned throughout this process? I realized I need to give myself a little grace. This stuff isn’t intuitive to anyone (unless you’re some sort of health insurance guru). I shouldn’t beat myself up because the system is more complicated than it needs to be. And bottom line is that I need to focus on the fact that I have choice when it comes to health insurance, period, because I know that there are too many people out there who can’t say the same.

So I guess in a way I am glad for the challenges presented to me by my health coverage.

DASHed Hopes No More

I have some exciting news…I’m switching to the OmniPod DASH!

While I won’t start using my DASH until after my old OmniPods are used up (first generation OmniPods aren’t compatible with the DASH PDM), I’m still really excited about switching things up. Nearly a year ago, I expressed my desire to switch to the DASH in addition to my frustration that it would be more expensive for me to make the change.

But with a new job comes new health insurance and a whole new set of “rules” that I’ve been figuring out in the last couple of months.

And let me tell ya…it hasn’t been easy. But more on my struggles to get my basic diabetes prescriptions filled under my new health insurance to come in a blog post very soon…

Violet is excited about my new DASH PDM, too!

Anyways, back to the DASH. When I called Insulet to report a failed pod not too long ago, the representative I was speaking with was asking me if I’d heard about or was interested in the DASH system. Normally, I would’ve brushed her off and explained that I was only interested in getting a replacement for my failed pod that day, but I happened to have some spare time on my hands and decided to ask her if she could see if/how my new insurance would cover the DASH.

She kindly did some research and reported back to me that yes, it was indeed, and that all I’d have to do is get my doctor’s office to prescribe some DASH pods to me and in the meantime, Insulet could send my DASH PDM to me so that I had it on hand when I was ready to start using it. What really sold me, though, was the price – I’d be paying less for a 90-day supply of DASH pods than what I was paying for regular OmniPods under my old health insurance plan.

It was a no-brainer, really.

Even though I’m not DASHing away to start up my DASH (again, gotta make use of those old pods first), I’m still looking forward to getting acquainted with a new piece of diabetes technology that will feel familiar to me because of my years on the OmniPod system. I can’t wait to share more when I finally get DASHin’!

On a Scale of 1-10, How Satisfied Are You with Your Health Insurance Plan?

The title of this blog post is a question that I was asked on a phone call with a member of my healthcare team. And the answer to it really stumped me.

On the one hand, I am extremely grateful to be employed with a workplace that offers a few choices in terms of a healthcare plan. I know that there are many Americans who are not as lucky as me and either struggle to afford medical care as needed or lack a job and/or health insurance altogether. It feels selfish for me to complain at all about my health insurance because I should just feel lucky to have it, period.

If you were asked this question, how would you answer it?

On the other hand, I’d be lying if I said I was 100% satisfied with my health insurance plan. I pay a lot of money out-of-pocket to cover the costs of all my diabetes supplies. I try to help mitigate the expenses by contributing to an FSA account, but it doesn’t do anything to lower the actual costs of my supplies: It just means that I save an amount equal to the taxes I would have paid on the money I set aside.

So when I was asked how I’d rate my health insurance plan using a scale of 1-10, 1 being the worst possible plan and 10 being the best possible plan, I didn’t know which side of the argument I should go with. I know that I certainly don’t have the worst plan – for the most part, I’m able to freely choose things like which insulin pump I want to use and which doctors I want to see – but I definitely don’t have the best plan. To me, the best plan would mean I don’t pay anything for the medications and supplies that I need in order to live, so I absolutely wasn’t going to give it a 10 rating.

Ultimately, I answered the question by giving my health insurance plan a 3. I am dissatisfied with the amount of money that I need to pay and wish that my plan would shoulder more of the costs, but the plan earns a few points for the flexibility it gives me in terms of who I see for doctors and for being consistent in the last couple of years that I have spent on it.

As I said the answer out loud, I couldn’t help but think and dream about the day that I might be able to give a health insurance plan a 10 because it covers all medical costs, is easy to understand, and provides freedom to choose any medications, devices, and doctors that I want. It’s a hope that I have not just for myself, of course, but for all Americans.

I hope that day comes sooner rather than later.

Stress, Anxiety, and Health-Care Open Enrollment

Open enrollment season has officially started and I am officially stressed about it.

Like many employed Americans, I have health insurance through my workplace plan. My yearly opportunity to choose my benefits for 2021 kicked off on October 15th and I have until the 29th to make my elections.

I can’t stand open enrollment season.

What, exactly, makes me so anxious about open enrollment? Well, for starters, I’m never certain that I’m choosing the best plan for me. I know that I’m extremely lucky to be able to choose between three different options – many others aren’t so fortunate – and truly, my company offers tools to make the process as smooth and understandable as possible.

But…health insurance matters are confusing!

There’s too much math involved for me, a person who considers herself allergic to basic arithmetic!

There’s too much unpredictability in it all – how am I supposed to know how many times I may need to meet with specialists next year? How am I supposed to forecast any possible health issues besides my diabetes? How do I go about guessing things that are impossible to guess?

Do I stick with the plan that I’ve been on for the last year and a half or so, that has high co-payments for my doctor appointments but the lowest deductible? Or do I change it up and go on a high deductible plan with a lower premium?

Please reassure me that I’m not the only person with diabetes who absolutely loathes this entire process and overthinks it every step of the way…

3 Things I’ve Learned Since Switching to my Own Health Insurance Last Year

Just over 365 days ago, I made the switch from my parents’ health insurance plan to my own plan, provided by my employer.

In the last year, I’ve learned some important lessons about being responsible for my own healthcare coverage. Some lessons were easier to learn than others. I figured it might be helpful to others who just made the switch themselves (or who will be doing so in the near future) for me to sum up three big takeaways I’ve discovered along the way in the hopes that it makes the transition a little easier for those individuals, or at least saves them some time down the road.

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Navigating the confusing world of health insurance has taught me quite a few lessons in the last year.

  1. Take advantage of a flexible spending account (FSA), if the option is available. I grew up knowing that FSAs exist – my parents would always bring their FSA account cards to all my doctor’s appointments and pay for all of my supplies using those cards – but I had no idea what the big deal was about them until I switched to my own health insurance plan. Basically, FSAs are a great employer-sponsored benefit because they allow account holders to pay for eligible medical expenses on a pre-tax basis. So those who have an FSA are able to pay for things they need tax-free, and the money is typically available to account holders on the first day of the health insurance plan year. My current health insurance plan allows a maximum contribution of $2,300, so I was able to put up to that amount on my account for 2020. It really comes in handy because my wallet doesn’t take as much of a beating from all of my necessary (and very expensive) diabetes supplies, and unlike the last half of 2019, I’m not paying as much out of pocket after my deductible is met.
  2. Keep records of everything. It might seem fussy to hold onto any and all receipts or transaction records, but there might come a day when one is needed. Case in point? At the end of 2019, my company announced during open enrollment that our FSA administrator was changing…which, at the time, I didn’t think was a big deal. I knew what the maximum contribution was, and I figured I’d only need to log into my FSA account sporadically to see how much money I had left for the year. Well…I was wrong about that. Back in February, I got a notification that I needed to submit verification of purchases of my regular OmniPod shipment, Dexcom sensors and transmitters, and my Humalog prescription. And you can bet your bottom dollar I didn’t have receipts for all three of those transactions because, well, my old FSA provider never once asked for receipts. As silly as it sounds now, I guess the thought never crossed my mind that my new FSA administrator would need purchase records. Long story short, I was able to submit an explanation of benefits in lieu of the receipts, but it would’ve been easier just to hold onto the original records (and I can assure you I’ve done that since this whole incident).
  3. Don’t be afraid to ask questions when things don’t add up. I had my annual physical in January and I had quite the shock when I was billed over $300 for all of the lab work that my primary care physician had me do. The moment I got that charge, I knew something wasn’t right – never before in my life have I been charged that much for a standard battery of tests that I take for my physical. So I wrote in to my PCP’s billing department and asked about the charges. That’s when I learned that I was mistakenly charged this amount and that I needed to reach out to my health insurance provider to re-run the charges. Although it was a little annoying to have to go back and forth between my health insurance provider and my PCP’s office, it was worth it because I saved myself $300 that I never actually owed in the first place. This taught me the importance of asking questions and following up with people until I understand, well, anything that’s confusing to me when it comes to my health insurance.

 

My New PDM

After four years filled with various highs and lows, I had to say farewell to the PDM that was virtually glued to my side, working with me to manage my diabetes.

Our parting was inevitable. Around the Fourth of July, I noticed that the battery symbol on my PDM was low, meaning that the triple A batteries within needed to be replaced. I put fresh ones in, but upon the system restarting, the PDM asked me to input information such as the date and time. And then…the pod I’d been wearing for less than 24 hours beeped loudly, signaling to me that it had failed. I figured it must be due to the battery replacement, but this definitely wasn’t normal. So I did some investigating.

I consulted with my mom and she told me that this was a sign that the internal battery within the PDM, the one that cannot be replaced, was starting to run out of life. She advised me to call Insulet to get a replacement PDM. That’s how I discovered that the warranty on my PDM actually expired in January of this year, and that I’d have to pay a nice chunk of change (about $500) to get a new one, under warranty.

It was a painful process, as I’ve detailed in recent posts, but I finally did get my new PDM. Fortunately, it only cost me $100 (I guess I should be glad I met my $900 deductible so quickly).

My New PDM.png
A very special delivery.

I waited to power up the new system until I was due to change a pod – didn’t want to waste a pod if I didn’t have to – and I’m really glad I set aside a half hour or so in order to input all of my settings into the new PDM. It was a bit stressful, really, and just as I was cursing the PDM for not automatically knowing all of this stuff about me, it was set up and ready for action.

It was a strange feeling, disconnecting myself from that PDM I’d relied on for four years. It sounds dramatic, I know, but that PDM and I have been through a lot. As I powered down the system, I had a little moment and felt gratitude toward the PDM (and I suppose all of its little quirks). I put it inside the box that the new one arrived in, and the old PDM now sits in my diabetes supplies cabinet, neatly tucked away so in the event that I need to consult it for old information or data, I can.

And now I can say I’ve got a shiny, pristine PDM that’s under warranty, which I must admit is a relief.

3 Tips For Anyone Turning 26 with Diabetes (and Switching Health Care Plans)

Do you have diabetes and will turn 26 in the near future? Will you be forced to switch from your parents’ health insurance to your own plan? If the answer to both of those questions is “yes”, then you’ll definitely want to take a minute to read my tips on how to make the transition as smoothly as possible. And even if you answered “no”, you still might find this to be a worthwhile read because chances are, either you or someone you know will have to go through this process, whether or not you/they have diabetes.

Here are the three most valuable tips I have for anyone who just turned, or is about to turn, 26 years old and is concerned about switching health care plans:

HUGGING THE CACTUS - A T1D BLOG
I figured out these tips the hard way. Save yourself a lot of frustration and time by following them A.S.A.P.

Tip #1: Ask your doctor for copies of all of your prescriptions. Do this well before your actual birthday. That’s what I did, anyways – I had a scheduled appointment with my endocrinologist at the end of April. That’s when I requested a copy of every single prescription she’s ever written for me, including for medications that I don’t really use anymore (e.g., Lantus, the long-acting insulin I used prior to my insulin pump). Then, I made multiple copies of these prescriptions, taking care to separate the originals from the copies. This tip really came from my mother, who told me that having the prescriptions now would save me trouble later. And she was right: When I did send in my Humalog prescription to Express Scripts, I did so with more confidence because I didn’t have to scramble to request it from my doctor.

Tip #2: Start the process of reordering supplies as soon as possible. Even if it means starting to reorder things on your actual birthday…do it. I’d say this is especially important if you’re running low on supplies. It took me nearly two months to start receiving stuff. Part of this was my fault because I procrastinated, and was also at an advantage because my mother took the time to order me plenty of extra supplies before I made the switch. But it was also the fault of the companies I was ordering from, who, for various reasons, didn’t send out my supplies on time or needed a longer period of time to review my orders before shipping them out. I’m lucky that I can say that I was never truly worried that I was going to run out of supplies, but the thought did cross my mind a few times, and it was unpleasant. So save yourself from aggravation and just get the ball rolling as soon as you can.

Tip #3: Keep records of everything. I keep a physical folder that contains receipts, prescriptions, photocopies, notes, and various other documents related to my health. I can’t say for sure what I’ll actually need to keep or throw away in the coming months, but I do know that it’s smart to hold onto this stuff in the beginning. That way, during my company’s next open enrollment period, I’ll be able to make informed decisions regarding things like how much money to put in my flexible spending account (FSA). Plus, any notes that I’ve taken during phone calls have already proved immensely helpful as I’ve needed to track down specific customer service representatives in order to take care of issues that have come up. It can be a little cumbersome to remember to keep all these papers, but I know it’s the right thing to do and that there’s no way that I’ll regret it.

BONUS Tip #4: Advocate for yourself until you get what you need. At first, I felt extremely awkward for calling Dexcom and Insulet every single day for a week. But then I realized that I shouldn’t. They weren’t going to make sure that I had my supplies: I had to depend on myself to do that. I also felt a bit stupid asking just about every customer service representative that I spoke to how everything works, but I eventually got over that, too, because it’s vital to understand this stuff, even when it seems extraordinarily complicated. So I’d tell anyone who’s going through this process, or who is about to go through it, to keep up the hustle. Don’t ever feel shame for asking too many questions or calling too many times; when it comes to all this, the limit doesn’t exist. Ask others for help when you need it (I spoke with all sorts of people in the DOC about my issues, and goodness knows that my mother provided me with all sorts of advice and support throughout this) and, with their assistance and a little determination on your part, you’ll get through this tiresome transition.

Why is it so Difficult to Order Life-Saving Medical Supplies?

When it comes to obtaining my diabetes supplies – life-saving pieces of medical equipment – I’ve discovered that it’s not a simple process. It’s not exactly like purchasing something on Amazon with a single click. Rather, it’s a convoluted, head-scratching, infuriatingly long procedure that apparently involves multiple calls to a variety of companies.

As of this writing, it took approximately 4 calls to my endocrinologist’s office, 12-14 calls to Insulet (the maker of my OmniPod insulin pump), 6 or 7 calls to Dexcom (for my CGM supplies), 2 calls to my health insurance provider, and 1 call to Express Scripts just to get everything all straightened away. These calls took place over the course of 2.5 months, and as they grew in frequency, so did my overall frustration and confusion.

The biggest headache was definitely caused by the lack of effective communication between Insulet and my endocrinologist’s office. I needed to get a new PDM, and Insulet’s job was to contact my doctor’s office and get a letter of medical necessity in order to get a PDM shipped out to me. Simple, right?

Why is it so Difficult to Order Life-Saving Medical Supplies_
My call log looked like this for several days in July – so many phone calls to Insulet/OmniPod and to my doctor.

Far from it. About a week after I placed the order for the new PDM, I got an email from Insulet saying that my doctor’s office had failed to return their faxes. I was advised to contact them to determine the delay. When I did, I spoke with a receptionist who, despite my clear explanation of the issue, misunderstood what I was asking for and left me a voicemail to say that she didn’t know what Insulet was talking about seeing as their information showed that I had received a shipment from them. (For whatever reason, she thought I needed more pods, which I did have delivered around the same time that all of this was going on.)

After several more back-and-forth phone calls, I cracked the case wide open: Insulet had the wrong contact information for my doctor. While my endocrinologist hasn’t changed in about a decade, her office location has, and Insulet still had the old one. I felt like an idiot for not realizing this sooner, but then again…why was I the one who was jumping through so many hoops and making so many contact attempts in order to figure out what the hold-up was? It was absolutely ridiculous, but I certainly felt relieved – and satisfied – to have personally solved the mystery.

I wish I could say I had a better experience with Dexcom, but that proved to be similarly headache-inducing. I thought that I was set to receive my supplies after I’d signed a payment plan for a 90-day supply of sensors and transmitters, but when they didn’t show up after a month of waiting, I knew something was wrong. I called Dexcom and discovered that the order, for reasons unknown, just didn’t process, so I had to sign a brand-new payment plan and had my case assigned to a different customer service rep. I was pretty pissed off by the lack of communication, but the one silver lining was that I’d already managed to pay my deductible in full (ha, no surprises there), so my Dexcom supply order would cost me less. Again, it was unbelievable that I never got an update from the company regarding my order’s status, but I did feel a sting of pride in myself for getting it all worked out on my own.

I don’t know why everything about this process is so agonizing. But what I do know for sure is that it seems that the only person I can count on to get my supplies ordered properly, in the end, is myself.

Navigating Health Insurance Hell

I am one month into my new health insurance plan, and I’m more confused than ever.

I’ve sent several emails. I’ve engaged in a number of live chats. I’ve made countless calls to my insurance company, my insulin pump provider, a mail-in pharmacy service, and my CGM provider just to try and get some answers. And almost every time I hang up the phone or walk away from the chat service, I feel lost because nothing is clear to me.

Am I stupid?

Keep track of your fitness at www.reallygreatsite.com.png

I can’t be the only one who just doesn’t get how it all works…right?

Why can’t I just get definitive answers as to how much I’ll need to pay for insulin each month?

Why does my health insurance company advertise a partnership with a mail-order pharmacy that puts a cap on insulin costs…when in reality, it doesn’t (or at least, nobody has informed me that it does)?

Why am I learning, at this stage in the game, that my prescription plan isn’t integrated with my medical plan, which means that any prescriptions I fill using the mail-order service don’t qualify towards my deductible?

Why is it all so convoluted?

As mystified as I am by all of this, I’m coping with a strategy that my parents have helped me develop, which I’ll share with you: Anyone who is going through all of this right now, or anyone who is about to go through all of this, needs to remember to be their own advocate. (I’m reminding myself to do this on the daily.) Frequently, I tell myself that I have every right to make as many phone calls or contact efforts as needed until I understand the costs associated with reordering my supplies. Although it’s easy to get frustrated when a representative on the phone speeds through an explanation or provides contradictory information, it’s important to stay focused on the task at hand.

As I continue to figure all of this out, I’m going to take note of questions that crop up and have a notepad and pen in hand any time I make a call. I’m keeping track of all messages exchanged online and I’m using the next couple of weeks as my fact-gathering stage. It’s almost like I’m assembling pieces to a puzzle…a ginormous, complicated puzzle, but one that will result in a more complete picture of the cost of my prescriptions going forward.